Payers are trying to figure out how behavioral health fits into the value-based care paradigm as the demand for innovative contracting grows.
One of the main places payers are pushing for integration is with primary care. Still, integrating primary care and behavioral health in a value-based care arrangement can be difficult. Primary care providers often lack the data capabilities and incentives to adopt a fully integrated model.
Some payers are looking to solve these issues by giving providers more data to help their patients and incorporate behavioral health into value-based care quality metrics.
“Integrated primary care–we’ve all heard that phrase, but what does that really mean?” Samantha Chafin, senior director of behavioral health strategy and operational integration at Florida Blue, said during a Behavioral Health Tech 2023 panel last week. “It comes down to how we are helping and empowering primary care providers with actionable data.”
Founded in 1945, Florida Blue is a health plan that covers more than 5.9 million Floridians.
Chafin noted that data can allow providers and health plans to provide individualized care and guidance.
“We have been empowering our primary care providers with data through our provider portal and reporting that really embraces both the physical and behavioral health results and outcomes,” Chafin said. “I’m proud to say that at this point, all of our primary care medical adult provider value-based arrangements include at least one behavioral health quality metric. Where the money goes drives action.”
While the bulk of value-based care integration conversations have focused on primary care and behavioral health, specialty care could be a ripe place for innovation.
“It was actually oncology bundled payments that really first [brought to] the forefront the idea of having a behavioral specialist in their practice,” Chafin said. “They knew the importance of addressing mental wellbeing for those individuals who are in cancer treatment.”
But oncology integration is just the start. Florida Blue is now focusing on integrating behavioral health care into other specialties, including OB-GYN and pediatric value-based arrangements, according to Chafin.
Using data
Identifying patients in need can also be challenging. But, data can help health plans pinpoint patients needing behavioral health support. For example, SCAN Health Plan has partnered with the digital behavioral health company Lucet to help find members who could benefit from behavioral health services.
Through this partnership, SCAN can review a member’s medical and pharmacy claims, as well as their behavioral health responses to an annual health risk assessment, according to Wendy Zhao, associate general manager at SCAN Health Plan.
“When we see a member who hasn’t had behavioral health service or an appointment with Lucet yet but has a medical diagnosis for a behavioral health condition or is on medication for a behavioral health need … we can proactively identify that member,” Zhao said.
SCAN Health Plan provides Medicare coverage to California, Arizona, and Nevada seniors.
The technology partnership can give physical care providers a referral option and enable members to have more choices. The Lucet-SCAN partnership also allows members to share their behavioral health preferences. This can also inform SCAN about its blindspots in its behavioral health network.
“We can be smarter about how we design the network,” Zhao said. “We’re not just going out and saying okay, we’re just going to meet the CMS network adequacy minimum and get the psychiatrist in this county to meet the requirement.”
If more members request a specific type of therapist from a particular background and there is a long wait time for that provider, SCAN can use that information when building its network accordingly.
Provider buy-in
While technology can help boost behavioral health integration into physical health care, getting provider buy-in can be challenging. It may require payers to cover some of the costs.
“We needed to look for ways to bring technology to our provider partners that wasn’t going to cost extra,” Chafin said. “Better yet,[the technology] optimizes their practice and improves their revenue and profitability.”
In addition to removing the cost burden from providers, payers may need to provide provider education about integrating technology into their practice.
“It’s on us at SCAN and Lucet to really integrate our programs with the medical groups and the PCPs,” Zhao said. “Make sure they understand there is access. Don’t be afraid to refer; this is how you can refer through secure email, over the phone, or on a portal. Let’s make it easy for our providers to remove the roadblocks and the bottlenecks.”
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